A Look at Suicide Rates Ahead of 988 Launch—A National Three-Digit Suicide Prevention Hotline

Nearly half a million lives (480,622) were lost to suicide from 2010 to 2020. During the same period, the suicide death rate increased by 12% and as of 2009, the number of suicides outnumbered those caused by motor vehicle accidents. On July 16, 2022, the federally mandated crisis number, 988, will be available to all landline and cell phone users, providing a single three-digit number to access a network of over 200 local and state funded crisis centers. 988 callers who are suicidal or experiencing a mental health crisis will be routed to the National Suicide Prevention Lifeline and connected to a crisis counselor where they may receive crisis counseling, resources and referrals, and in some cases and where available, mobile crisis units may be dispatched.  While 988 is intended to help fill gaps in the behavioral health crisis continuum, there is concern about the National Suicide Prevention Lifeline’s  readiness to handle the increased volume, which is expected to triple from 4 up to 12 million calls in the first year alone. In this issue brief, we use 2010 to 2020 CDC WONDER data to examine trends in suicide rates over time and by race and ethnicity, sex, age, and state, ahead of the implementation of 988.

Suicide deaths increased between 2010 and 2018 and then slowed in 2019 and 2020, although some research suggests suicide deaths are undercounted. The overall number of suicide deaths peaked in 2018 and then decreased slightly in 2019 and 2020, although some research suggests that some suicides may be misclassified as drug overdose deaths since it can be difficult to determine whether drug overdoses are intentional. Deaths from drug overdoses increased by 31% between 2019 and 2020, but the suicide death rate was similar.

Suicide deaths by firearms accounted for more than half of all suicides in 2020. Between 2010 and 2019, there were similar numbers of suicides by firearms as by other means. However, in 2020, there were more suicide deaths by firearm compared to suicide deaths by other means, as suicides by other means decreased by 8% and the number of suicides by firearms remained roughly stable (Figure 1). Suicide deaths accounted for more than half (54%) of all deaths involving a firearm in 2020.

Suicide death rates in 2020 were highest among American Indian and Alaska Native people, males, and people who live in rural areas. As of 2020, American Indian and Alaska Native people had the highest suicide death rate at 23.9 per 100,000 people, nearly one and a half times higher than the rate for White people (16.8 per 100,000 people). Suicide death rates for Black, Hispanic, and Asian and Pacific Islander people were all less than half the rate for White people. Females are more likely to report mental illness and are more likely to attempt suicide, but male suicide death rates are four times higher (22.0 per 100,000 versus 5.5 per 100,000). Non-metropolitan areas have a higher suicide rate (19.1 per 100,000) than metro areas (12.6 per 100,000). There are similar suicide rates across adult age groups in 2020 (Figure 2). However, because younger people are less likely to die of other causes, suicides are the second leading cause of death in adults under the age of 45, accounting for 16% of deaths in people 18-25 and 9% of deaths in people 26-44.

Suicide deaths are increasing fastest among people of color, younger individuals, and people who live in rural areas. Between 2010 and 2020, suicide death rates increased substantially among people of color, with the highest increase among Black people (43% increase, from 5.4 to 7.7 per 100,000), followed by American Indian or Alaska Native (41% increase, from 16.9 to 23.9 per 100,000), and Hispanic (27% increase, 5.9 to 7.5 per 100,000) people (Figure 2). Other studies show a particularly large increase in suicide deaths among Black youth and adolescents. Underdiagnosis of mental health conditions, structural barriers to care, stereotypes and discrimination associated with poor mental health, racism and discrimination, and disparities in the use of mental health services may all contribute to rising suicide rates among people of color. In rural areas, suicide death rates increased significantly, possibly due to acute shortages of mental health workers in these areas. The suicide death rate also increased in adolescents (62% increase, from 3.9 to 6.3 per 100,000) and young adults (33% increase, from 12.8 to 17.0 per 100,000) between 2010 and 2020 (figure 2).

Suicide death rates varied substantially by state in 2020, as did the rate of change from 2010 to 2020. Suicide death rates by state range from a low of 5.5 per 100,000 population in Washington, D.C. to a high of 30.5 in Wyoming, with a median death rate of 15.2 per 100,000 in 2020 (Figure 3). The suicide rate may vary by state due to factors such as demographics, firearm availability (involved in over half of suicides), mental health status, and access to mental health services. Between 2010 and 2020, suicide death rates increased by 25% or more in 9 states, with the largest increases in Wyoming (36% increase, from 22.4 to 30.5 per 100,000), West Virginia (38% increase, from 14.1 to 19.4 per 100,000), Nebraska (43% increase, from 10.4 to 14.9 per 100,000), and Iowa (49% increase, from 12.1 to 18.0 per 100,000).

988 is expected to fill gaps in mental health crisis care and decrease adverse events and suicides, but uncertainty remains. The federal government mandates 988, but states are responsible for most of the funding and implementation. Almost one month before 988 launches, many crisis counselor hotline positions remain unfilled, a long-term funding strategy is unclear, and the community crisis infrastructure varies greatly across states and localities. While 988 is expected to improve the delivery of mental health crisis care, it is unknown how well it will address the needs of those who are most vulnerable, including some people of color, males, younger individuals, and individuals living in rural areas.

If you or someone you know is considering suicide, contact the National Suicide Prevention Lifeline at
1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889).

This work was supported in part by Well Being Trust. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

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